NHS emergency care is “out of control” across large swathes of the country,
the chairman of the health and social care watchdog has warned.

Too many patients — especially the elderly — are arriving in hospital as an emergency, when they should have received help much earlier, said David Prior, head of the Care Quality Commission (CQC).

As a result, he added, the healthcare system is on the brink of collapse and regulators cannot promise to prevent further scandals like Mid-Staffordshire.

In his first major speech since being appointed to lead the regulator earlier this year, Mr Prior called for large-scale closures of hospital beds and investment in community care.

He said that almost half of hospitals are providing care which was either poor, or “not terribly” good. The CQC has identified 45 hospitals which have had problems which date back five years. And he criticised the decision to allow GPs to opt out of out-of-hours care, saying that they should be available to patients around the clock.

In a forthright speech to a conference held by health think tank the King’s Fund, Mr Prior said: “If we don’t start closing acute beds, the system is going to fall over.

“Emergency admissions through Accident & Emergency (A&E) are out of control in large parts of the country … That is totally unsustainable.”

The former Conservative MP, who took up the leadership of the health and social care regulator in January, said there was no real market in health care, leaving many patients at the mercy of their local hospital, regardless of its quality.

“The patient or resident is the weakest voice in the system,” he said. “It is a classic market failure —the user doesn’t know nearly as much as the professionals, even with the Internet.”

“We can talk about competition until the cows come home but if you live in Norwich there is one hospital,” said the former chairman of Norfolk and Norwich University Hospitals foundation trust.

Mr Prior said the regulator existed because the market could not be left to its own devices, as communities relied on their local hospitals.

“There is the nature of health care — people die. If you buy a fridge and it doesn’t work, you can buy a new fridge. If health care goes wrong you can die.”

He made the comments as new research revealed that almost one in 10 patients suffers harm in NHS hospitals and care homes.

The data from the NHS Information Centre examined safety incidents in the last month, and found eight per cent of patients had been harmed during their care — suggesting that every year more than one million patients and care home residents suffer avoidable harm.

Bedsores were the most common result of neglect, with 5.6 per cent of patients suffering from such pressure ulcers, which can be fatal. The other main causes of harm were falls, urinary tract infections linked with catheter use and blood clots.

Mr Prior, who was brought in to lead CQC after it was criticised for repeated failures to protect vulnerable patients, said the organisation would now play “a huge role” in debates about hospital closures and decisions to reshape services and move more care into the community. Many frail elderly people who ended up in hospital should not be there, he said.

The regulator has embarked on a new strategy with bigger teams of experts to carry out in-depth inspections.

Mr Prior said its assessment of NHS services suggested that close to half of hospitals are now providing care which was either poor, or “not terribly” good.

Mr Prior said CQC had identified about 45 hospitals which have had serious problems dating back around five years and that in future regulators will take a “much clearer” approach in advising which hospitals should not be allowed to continue as they are.

“We will be outside the system and the politics - we will have a huge role in the reconfiguration debate because we are independent,” he said.

The 45 hospitals which will now be a priority for inspection make up about 20 per cent of those in England, he said, while describing a further 20 percent as “coasting along ... not doing terribly well.”

The CQC chairman said he did not believe the regulator could promise to prevent future scandals.

“We cannot give the public a cast-iron guarantee that there will never be another Mid Staffs or another Maidstone & Tunbridge Wells [where hundreds died after an outbreak of Clostridium difficile]” he said.

Mr Prior said the decision by the previous Government to allow family doctors to give up responsibility for out-of-hours care had let patients down.

“I think primary care is in bad shape,” he said. “I think GPs ought to be responsible 24/7 - they should never have opted out from out of hours care.

His comments reflect increasing alarm about the risks being posed to patients amid a massive rise in demand for A&E services, which are struggling to cope, and about the quality of care given to elderly people in hospital.

Mr Prior told the conference in London that he believed that a “financial crisis” across the NHS and social care would drive services to integrate, and to invest in community care, because there was a perception doing so would save money, though there was little evidence such services are cheaper.

Last weekend it emerged that at least 22 serious incidents - including three deaths - are under investigation since the disastrous rollout of the 111 non-emergency phone line, which was intended to relieve pressure on A&E departments and improve out-of-hours care.

Norman Lamb, care minister, said the pressures on hospitals had been created because patients had lost confidence in the care which is provided when their GP surgery was closed.

“We have out-of-hours care that too often falls down. People end up with the default option of A&E because there is nothing else that they are confident in,” he told the same conference.

Next week the minister will announce pilots for “integrated care systems” where groups of local NHS organisations and councils devise their own payment systems to stop elderly people being stuck in hospital amid warring between the NHS and social services over who foots the bill.

Mr Lamb said: “We have institutionalised fragmentation of care over the years. Where does the poor patient fit into this, how do they make sense of it? We need a system that promotes integration not crushes it.”

Other speakers said that making further cuts to the number of hospital beds in England could mean yet more patients were left to suffer.

Professor David Oliver, former national clinical director for older people said that the loss of more hospital beds would mean more elderly people would be left being treated in corridors and “on any flat surface available.”

The visiting fellow at the King’s Fund said the UK had lost one third of its acute hospital beds in the last two decades, leaving services with fewer beds per head of population than any comparable country.

He said hospital A&E departments were under “inexorable” pressure because GP surgeries did not provide enough care for older people, often missing conditions like osteoporosis and arthritis, and that the number of beds for patients rehabilitating from hospital care should be doubled.

“How do you take capacity out of acute [hospital] provision when people are still piling through the doors in record numbers and hospitals are so pressurised?” he asked. “What happens - if you take the capacity out - is that people end up being treated on any flat surface and in the hospital corridors.”